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https://www.readbyqxmd.com/read/29768079/the-spectrum-of-surgical-remediation-of-transoral-incisionless-fundoplication-related-failures
#1
Ruchir Puri, C Daniel Smith, Steven P Bowers
AIM: To evaluate outcomes of surgical remediation for symptomatic or anatomic failure after a transoral incisionless fundoplication (TIF). METHODS: This retrospective study was performed on 11 patients who underwent a remedial operation following TIF failure between June 2011 and September 2016 at the Mayo Clinic in Florida for persistent foregut symptoms. Upper gastrointestinal workup characterized 1 patient as having normal post-TIF anatomy and 10 as having anatomic failure...
May 16, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/29733014/peroral-endoscopic-myotomy-versus-heller-myotomy-for-achalasia-pros-and-cons
#2
Cristian Tefas, Rami Ababneh, Marcel Tanţău
Achalasia is an esophageal motor disorder that has multiple endoscopic and surgical methods of treatment. However, there is no consensus on optimal therapy in patients suffering from this disorder. This review discusses two therapies with similar but technically different concepts, peroral endoscopic myotomy and Heller surgical myotomy. After a brief introduction to the basic problems of achalasia, technical considerations, intra and postprocedural complications are presented and the advantages and disadvantages of the two procedures are discussed, based on the relevant articles in the literature...
March 2018: Chirurgia
https://www.readbyqxmd.com/read/29712596/the-treatment-of-achalasia-in-obese-patients
#3
REVIEW
Julie A Wesp, Timothy M Farrell
Epidemiological studies have demonstrated that obesity is frequently associated with esophageal motility disorders. Morbid obesity and achalasia may coexist in the same patient. The management of the morbidly obese patient with achalasia is complex and the most effective treatment remains controversial. The aim of this study is to review the pathophysiology, clinical presentation, diagnostic evaluation, and treatment of achalasia in morbidly obese patients. EVIDENCE REVIEW: PubMed search from January 1990 to July 2017, including the following terms: achalasia, morbid obesity, bariatric, and treatment...
April 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29712595/laparoscopic-heller-myotomy-versus-per-oral-endoscopic-myotomy-evidence-based-approach-to-the-treatment-of-esophageal-achalasia
#4
Francisco Schlottmann, Marco G Patti
Esophageal achalasia is a rare disorder characterized by a failure of the lower esophageal sphincter to relax during swallowing, combined with aperistalsis of the esophageal body. Treatment is not curative, but aims to eliminate the outflow resistance caused by the nonrelaxing lower esophageal sphincter. Current evidence suggests that both laparoscopic Heller myotomy and per oral endoscopic myotomy (POEM) are very effective in the relief of symptoms in patients with achalasia. Specifically, for type III achalasia, POEM may achieve higher success rates...
April 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29712594/poem-for-achalasia
#5
Daniel A Kroch, Ian S Grimm
In 2008, a new treatment modality for esophageal achalasia was introduced-peroral endoscopic myotomy (POEM). POEM is a procedure performed endoscopically, which allows transection of the muscular fibers of the distal esophagus and of the lower esophageal sphincter. The procedure is therefore similar to a laparoscopic Heller myotomy without a fundoplication. Short-term studies have shown that POEM is very effective in relieving dysphagia and regurgitation, but concerns have been raised about the incidence of post-POEM gastroesophageal reflux...
April 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29712593/laparoscopic-heller-myotomy-and-fundoplication-what-is-the-evidence
#6
REVIEW
Fabrizio Rebecchi, Marco E Allaix, Francisco Schlottmann, Marco G Patti, Mario Morino
There is no agreement about the best type of fundoplication to add in patients undergoing laparoscopic Heller myotomy (LHM) for achalasia to reduce the risk of postoperative gastroesophageal reflux. This article reviews the current evidence about the outcomes in achalasia patients undergoing LHM with a partial anterior, a partial posterior, or a total fundoplication. We performed a review of the literature in PubMed/Medline electronic databases, which was evaluated according to the GRADE system. The results of the published randomized controlled trials show with a high level of evidence that the addition of a fundoplication reduces the risk of postoperative abnormal reflux, without impairing the food emptying of the esophagus...
April 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29712592/laparoscopic-heller-myotomy-for-achalasia-technical-aspects
#7
Francisco Schlottmann, Marco E Allaix, Marco G Patti
Esophageal achalasia is a primary esophageal motility disorder defined by the lack of esophageal peristalsis, and by a lower esophageal sphincter that fails to relax in response to swallowing. Patients' symptoms include dysphagia, regurgitation, aspiration, heartburn, and chest pain. Achalasia is a chronic condition without cure, and treatment options are aimed at providing symptomatic relief, improving esophageal emptying, and preventing the development of megaesophagus. Presently, a laparoscopic Heller myotomy with a partial fundoplication is considered the best treatment modality...
April 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29712591/endoscopic-pneumatic-dilation-for-esophageal-achalasia
#8
Sheraz Markar, Giovanni Zaninotto
Pneumatic dilation is a well-established treatment modality that has withstood the test of time. Prospective and randomized trials have shown that in expert hands, it provides results similar to a laparoscopic Heller myotomy with fundoplication. In addition, it should be considered the primary form of treatment in patients who experience recurrence of symptoms after a surgical myotomy.
April 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29684386/valuing-innovative-endoscopic-techniques-per-oral-endoscopic-myotomy-for-the-management-of-achalasia
#9
Eric D Shah, Andrew C Chang, Ryan Law
BACKGROUND AND AIMS: Unclear reimbursement for new and innovative endoscopic procedures can limit adoption in clinical practice despite effectiveness in clinical trials. The aim of this study was to determine maximum cost-effective reimbursement for per-oral endoscopic myotomy (POEM) in treating achalasia. METHODS: We constructed a decision analytic model assessing POEM versus laparoscopic Heller myotomy with Dor fundoplication (LHM) in managing achalasia from a payer perspective over a 1-year time horizon...
April 20, 2018: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29657705/laparoscopic-transhiatal-resection-of-a-large-mid-esophageal-diverticulum-a-case-report
#10
Tomislav Tokic, Iva Kirac, Davor Hrabar, Branko Troskot, Miroslav Bekavac-Beslin
This is a description of transhiatal laparoscopic approach for mid-esophageal diverticulum. Traditionally mid-esophageal diverticula are approached by thoracotomy or thoracoscopy, with the laparoscopic technique being reserved for epiphrenic diverticula. A 78-year-old Caucasian female with a secondary dilatative ischemic cardiomyopathy presented with dysphagia, tenderness in the epigastrium and a considerable weight loss. A large mid-esophageal diverticulum was found on barium swallow and confirmed by CT scan...
April 2018: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/29627183/value-of-routine-timed-barium-esophagram-follow-up-in-achalasia-after-myotomy
#11
Stefan S Kachala, Thomas W Rice, Mark E Baker, Jeevanantham Rajeswaran, Prashanthi N Thota, Sudish C Murthy, Eugene H Blackstone, Andrea Zanoni, Siva Raja
OBJECTIVES: The value of routine timed barium esophagram (TBE) in longitudinal follow-up of achalasia after Heller myotomy is unknown. We prospectively prescribed a yearly follow-up TBE. Purposes were to characterize esophageal emptying over time after myotomy, identify preoperative TBE measures associated with follow-up TBE, and characterize follow-up TBE over time in relationship to reintervention. METHODS: From March 1995 to April 2013, 635 patients underwent Heller myotomy for achalasia; 559 had at least 1 follow-up TBE...
March 8, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29608432/treatment-of-achalasia-with-per-oral-endoscopic-myotomy-analysis-of-50-consecutive-patients
#12
Erica D Kane, David J Desilets, Donna Wilson, Marc Leduc, Vikram Budhraja, John R Romanelli
BACKGROUND: Peroral endoscopic myotomy (POEM) has become an acceptable incisionless treatment for achalasia based on encouraging outcomes in multiple series worldwide. This report reflects our early experience. METHODS: Data were collected prospectively on all patients undergoing POEM between June 2011 and April 2016 under IRB approval. Diagnosis of achalasia was confirmed by standard preoperative work-up. Primary outcome was symptom relief, measured by Eckardt score...
April 2, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/29580341/laparoscopic-heller-myotomy-with-anterior-fundoplication-improves-frequency-and-severity-of-symptoms-of-achalasia-regardless-of-preoperative-severity-determined-by-esophagography
#13
Alexander Rosemurgy, Darrell Downs, Kenneth Luberice, Christian Rodriguez, Forat Swaid, Krishen Patel, Paul Toomey, Sharona Ross
This study was undertaken to determine whether postoperative outcomes after laparoscopic Heller myotomy with anterior fundoplication could be predicted by preoperative findings on esophagography. Preoperative barium esophagograms of 135 patients undergoing laparoscopic Heller myotomy with anterior fundoplication were reviewed. The number of esophageal curves, esophageal width, and angulation of the gastroesophageal junction (GEJ) were determined; correlations between these determined parameters and symptoms were assessed using linear regression analysis...
February 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29520414/-treatment-of-achalasia-laparoscopic-heller-myotomy-or-peroral-endoscopic-myotomy
#14
W Schröder, C J Bruns
No abstract text is available yet for this article.
March 8, 2018: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
https://www.readbyqxmd.com/read/29514836/uncommon-cause-of-dysphagia-paraneoplastic-achalasia
#15
Mukesh Nasa, Shashank Bhansali, Narendra Singh Choudhary, Randhir Sud
Achalasia secondary to underlying neoplasm is a rare entity. Early recognition of secondary achalasia is important as its treatment involves management of underlying malignancy, while treatment of primary achalasia mainly involves lowering the lower oesophageal sphincter pressure with pneumatic dilatation or Heller's myotomy. We discuss an interesting case of achalasia secondary to non-Hodgkin's lymphoma.
March 7, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29509532/high-resolution-manometry-a-mandatory-examination-in-the-pre-and-postoperative-assessment-of-patients-with-achalasia
#16
Anca Dimitriu, Cristian Gheorghe
High resolution manometry (HRM) is currently the gold standard for the diagnosis of achalasia and other functional esophageal disorders. All patients accusing dysphagia should be endoscopically evaluated prior to manometric investigations in order to rule out pseudoachalasia. The Chicago HRM classification has led to a subclassification of three manometric types of achalasia that seem to have different results to treatment. None of the actual achalasia treatment options are curative. Type II achalasia patients respond best to all treatment options compared to those with types I and III...
January 2018: Chirurgia
https://www.readbyqxmd.com/read/29475748/laparoscopic-heller-myotomy
#17
A Valverde, J Cahais, R Lupinacci, N Goasguen, O Oberlin
No abstract text is available yet for this article.
February 2018: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/29454796/endoscopic-myotomy-for-foregut-motility-disorders
#18
Mouen A Khashab, Petros C Benias, Lee L Swanstrom
Peroral endoscopic myotomy (POEM) is an advanced endoscopic procedure classically performed for the treatment of achalasia. The procedure is based on principles of submucosal endoscopy and is composed of a mucosal incision, submucosal tunneling, myotomy, and mucosal closure. Multiple published studies that collectively include more than 6000 patients reported clinical success in more than 80% to 90% of patients. Recent literature also suggested durability of response over a medium-term follow-up. POEM is associated with a low rate of adverse events when performed by experienced operators...
May 2018: Gastroenterology
https://www.readbyqxmd.com/read/29439587/clinical-management-of-pediatric-achalasia
#19
Marinde van Lennep, Michiel P van Wijk, Taher I M Omari, Marc A Benninga, Maartje M J Singendonk
Achalasia is a rare esophageal motility disorder. Much of the literature is based on the adult population. In adults, guidance of therapeutic approach by manometric findings has led to improvement in patient outcome. Promising results have been achieved with novel therapies such as PerOral Endoscopic Myotomy (POEM). Areas covered: In this review, we provide an overview of the novel diagnostic and therapeutic tools for achalasia management and in what way they will relate to the future management of pediatric achalasia...
April 2018: Expert Review of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29410262/laparoscopic-heller-myotomy-vs-per-oral-endoscopic-myotomy-patient-reported-outcomes-at-a-single-institution
#20
Andrew N Hanna, Jashodeep Datta, Sara Ginzberg, Kevin Dasher, Gregory G Ginsberg, Daniel T Dempsey
BACKGROUND: Although laparoscopic Heller myotomy (LHM) has been the standard of care for achalasia, per oral endoscopic myotomy (POEM) has gained popularity as a viable alternative. This retrospective study aimed to compare patient-reported outcomes between LHM and POEM in a consecutive series of achalasia patients with more than 1 year of follow-up. STUDY DESIGN: We reviewed demographic and procedure-related data for patients who underwent either LHM or POEM for achalasia between January 2011 and May 2016...
April 2018: Journal of the American College of Surgeons
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